Transitional cell carcinoma pathophysiology

Transitional cell carcinoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Transitional cell carcinoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging
History and Symptoms
Physical Examination
Laboratory Findings
Cystoscopy and Bladder Biopsy
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Transitional cell carcinoma pathophysiology On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Transitional cell carcinoma pathophysiology All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Transitional cell carcinoma pathophysiology
CDC on Transitional cell carcinoma pathophysiology
Transitional cell carcinoma pathophysiology in the news
Blogs on Transitional cell carcinoma pathophysiology
Directions to Hospitals Treating Transitional cell carcinoma
Risk calculators and risk factors for Transitional cell carcinoma pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Genetics

• Genetic mutations involved in the pathogenesis of bladder cancer include:

• HRAS mutation
• Rb1 mutation
• PTEN/MMAC1 mutation
• NAT2 slow acetylator phenotype
• GSTM1 null phenotype

Pathology

Gross Pathology

The following table illustrates the findings on gross pathology for the subtypes of transitional cell carcinoma:

Type	Description
Non-invasive urothelial carcinoma	Flat lesions or papillary lesions
Invasive urothelial carcinoma	Large infiltrative mass or a multifocal, flat to papillary lesion with delicate fronds

Microscopic Pathology

Non-invasive urothelial carcinoma

• Non-invasive urothelial carcinomas are only in the lining of the renal pelvis or ureter and have not grown deeper into the wall of the renal pelvis or ureter.

Invasive urothelial carcinoma

• Invasive urothelial carcinomas grow from the lining of the renal pelvis or ureter into the deeper layers of the renal pelvis or ureter wall, such as lamina propria and muscularis.
• Urothelial carcinomas with mixed epithelial features are invasive tumors that have different types of cells mixed with the cancer cells.
• They occur less often than typical invasive urothelial carcinomas and are generally considered to be more aggressive.
• The following table illustrates the findings on microscopic analysis for the subtypes of invasive transitional cell carcinoma:

Subtype	Features on Histopathological Microscopic Analysis
Urothelial carcinomas with squamous differentiation	Presence of urothelial and squamous cells Observed in 44% of renal pelvis tumors
Urothelial carcinomas with glandular differentiation	Presence of gland cells and true glandular spaces Mucin production Floating signet ring cells within the mucinous material
Micropapillary urothelial carcinomas	Have micropapillae High grade neoplasm
Sarcomatoid urothelial carcinomas	Have cells that look like sarcoma This aggressive carcinoma has often spread to lymph nodes and organs other than the renal pelvis or ureter when it is diagnosed
Nested variant of urothelial carcinomas	Irregular and confluent small nests and abortive tubules are composed of urothelial cells Very rare but aggressive
Microcystic urothelial carcinomas	Have cysts in them that can range in size from microscopic to 2 mm Very rare
Lymphoepithelioma-like urothelial carcinomas	Have lymphatic tissue mixed with urothelial cells, or transitional cells Very rare carcinoma More common in men than women
Plasmacytoid and lymphoma-like urothelial carcinomas	Have tumor cells that look like lymphoma or plasmacytoma
Giant cell urothelial carcinomas	Have abnormally large cells with more than one nucleus.
Clear cell urothelial carcinomas	Have clear cells (cells with clear cytoplasm and a large nucleus).
Lipid cell variant of urothelial carcinomas	Have cells that are filled with fat
Undifferentiated variant of urothelial carcinomas	Have cells that don’t have any clear features and don’t look like any other type of cell (they are undifferentiated).
Urothelial carcinomas with trophoblastic differentiation	Presence of cells that look like trophoblasts Human chorionic gonadotropin production within the cells

Grading

According to the WHO grading criteria, there are two grades of transitional cell carcinoma based on the degree of cellular differentiation:

Grade	Description
Low grade	Tumors with the least degree of cellular anaplasia Rarely invades the muscular wall of the bladder or spreads to other parts of the body Often recurs in the after treatment
High grade	Tumors with the most severe degrees of cellular anaplasia Commonly recurs and also has a strong tendency to invade the muscular wall of the bladder and spread to other parts of the body. High grade transitional cell carcinoma is much more likely to result in death